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Capsule colonoscopy vs CT colonography for patients with positive fecal occult blood tests

A study in the latest issue of Clinical Gastroenterology & Hepatology examines the accuracy of capsule colonoscopy and computed tomographic colonography in individuals with positive results from the fecal occult blood test.

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Computed tomographic colonography (CTC) is a reliable option for screening subjects who are unable or unwilling to undergo optical colonoscopy.

A colon capsule (PillCam Colon2 [CC2]) has shown promising results in detecting polyps larger than 6 mm.

Dr Emanuele Rondonotti and colleagues from Italy compared the accuracy of CC2 and CTC in identifying individuals with at least 1 polyp greater than 6 mm, and subjects’ attitude toward the procedures.

The team reported that 50 individuals with positive results from the immunochemical fecal occult blood test underwent CC2, CTC, and optical colonoscopy.

The unblinded colonoscopy was used as the reference standard.

78% of subjects said they preferred CC2 to CTC
Clinical Gastroenterology & Hepatology

In a per-patient analysis, the accuracy of CC2 and CTC were assessed for individuals with at least 1 polyp 6 mm or larger.

Individuals were asked to choose which procedure they would be willing to repeat between CTC and CC2.

The research team found that the combination of optical colonoscopy, CTC, and CC2 identified 16 cases with at least 1 polyp 6 mm or larger.

The team noted that CTC identified the polyps with 88% sensitivity, 85% specificity, a 3.0 positive likelihood ratio, and a 0.07 negative likelihood ratio.

CC2 identified the polyps with 88% sensitivity, 88% specificity, a 3.75 positive likelihood ratio, and a 0.06 negative likelihood ratio.

The researchers observed that 78% of subjects said they preferred CC2 to CTC.

Dr Rondonotti's team commented, "CC2 and CTC detect polyps 6 mm and larger with high levels of accuracy."

"These techniques are effective in selecting iFOBT-positive individuals who do not need to be referred for colonoscopy."

"CC2 seems to be better tolerated than CTC, and could be a reliable alternative to CTC for iFOBT-positive individuals who are unable or unwilling to undergo optical colonoscopy."

Clin Gastroenterol Hepatol 2014: 12(8): 1303–1310
01 August 2014

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